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The other day, a nurse asked me if a radiologist had to go to medical school. I was a little taken aback and quickly answered—likely a bit too defensively—that, yes, radiologists are physicians and we have to undergo five to six years of residency and fellowship training after medical school, more than many other physicians.

It wasn’t the first time I have been asked this question. It’s alarming how many non-physicians are unclear on this. According to a 2015 study published in the Journal of the American College of Radiology, only 56 percent of respondents identified that a radiologist is a medical doctor (J Am Coll Radiol. 2015 Jun;12(6):556-62).

Unfortunately, radiologists are often the unknown faces in a patient’s healthcare experience. It’s almost as though the images are sent into a black box, and then the patient’s physician magically calls with the result.

The radiology PR problem doesn’t end there. Even amongst physicians, radiologists face significant perception issues. Along with ophthalmology, anesthesiology and dermatology, radiology has traditionally been considered one of the "R.O.A.D. (radiology, ophthalmology, anesthesia, and dermatology) to happiness" specialties, which people associate with a great lifestyle and income.

Although radiology remains one of the better reimbursed specialties, much has changed with regard to lifestyle. I remember a joke I heard in medical school about the most dangerous place in the hospital being the hospital parking lot at 3 p.m., when the radiologist and the pathologist run into each other with their BMWs in their rush to get out of the hospital. Additional jokes that propagate stereotypes about radiologists are out there as well—we’ve all heard them.

Why Perception Matters

Every specialty has its own stereotypes and misconceptions. But that being said, I believe these perceptions legitimately hurt radiologists—and it’s not just about our egos. These are four examples of why it is important radiologists are better understood and treated with more respect:

- When administrators and other physicians perceive our lifestyle inaccurately, it makes it easier to expect more and ask for more. Between declining compensation, increasing imaging volumes, pressure for faster turnaround times and around-the-clock subspecialty reads, and increasing utilization of image-guided intervention, it’s hard to make the claim that most radiologist positions still fit the R.O.A.D. stereotype. If others had a better understanding of the current radiologist lifestyle as well as the significant challenges most groups face, radiologists could better protect themselves from financial cuts and unrealistic clinical expectations.

- When patients and referring clinicians don’t fully appreciate our roles in diagnosis, the credit received for the quality of our finished product, the radiology report, is diminished. If imaging centers and radiology suites are simply viewed as a place to go to get studies performed, location and ease of scheduling become the predominant factors in where a patient ends up. Although these are certainly important considerations for groups to keep in mind, we also invest time and money into our finished product, and it’s important for group survival for referring clinicians and patients to associate value with a particular set of radiologists.

- When patients don’t recognize our training and expertise, we lose the ability to weigh in on their decision making, even if we are amongst the best qualified to provide input on certain aspects of their care. The controversy surrounding screening mammography is a great example, especially as more medical societies are encouraging patients to speak to their physicians about when to begin screening.

- When a physician feels undervalued or overworked, his or her chances of experiencing burnout increase.

Fixing the Problem

For a few years, there has been a push at society meetings to “get out of the dark,” but it’s been hard for many groups to do this. We make our money reading studies, and taking time away from that for activities that aren’t billable is a hard (and sometimes impossible) hit for groups to swallow.

In addition, many feel that the trend toward factoring in RVU production in a radiologist’s compensation discourages radiologists from engaging in valuable conversations with clinicians and patients. If picking up the phone results in a 30-minute conversation, the lost RVUs from a couple of MRIs may be reason enough for a radiologist to avoid doing so.

This is a legitimate problem, but there are a few steps groups can take to help alleviate some of these problems in a relatively practical and financially neutral way.

For instance, we can and should embrace publicity more often, whether it be via social media or by a more conventional media/networking approach. Having physicians talk about topics like appropriate imaging workups for common problems, the importance of screening mammography and radiation safety on public platforms gives weight to the role of the radiologist as an expert consultant. Radiologist participation in tumor boards, hospital committees and grand rounds settings go a long way in showcasing the breadth of a radiologist’s training and expertise.

Although many groups may never be able to realistically incorporate systems that allow radiologists to regularly interact with patients in the department, we could certainly do a better job of displaying radiologist names, pictures and qualifications in radiology waiting rooms. Or what if we showed videos of radiologists addressing common questions? These one-time investments allow the patient to gain a sense of who is reading their study and the role that person plays in patient care.

Lastly, groups should increase contributions to our professional societies, with money specifically being targeted toward publicity and political advocacy. Each of us may not be able to spare the time as individuals, but our larger organizations may be able to make strides on a daily basis where we fall short.

Ultimately, radiologists do a lot of their work behind the scenes, and the less that patients and clinicians know and see us, the harder it becomes for us to have a say in the changing landscape of medicine. While each group’s approach to addressing these problems should be tailored individually, one thing is for certain—ignoring the problem has real consequences.

Nisha Mehta, MD, is a musculoskeletal and breast imaging radiologist at the VA Health Care Center in Charlotte, N.C.

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